Hazard regression model and cure rate model in colon cancer relative survival trends: are they telling the same story?

Hazard regression models and cure rate models can be advantageously used in cancer relative survival analysis. We explored the advantages and limits of these two models in colon cancer and focused on the prognostic impact of the year of diagnosis on survival according to the TNM stage at diagnosis. The analysis concerned 9,998 patients from three French registries. In the hazard regression model, the baseline excess death hazard and the time-dependent effects of covariates were modelled using regression splines. The cure rate model estimated the proportion of 'cured' patients and the excess death hazard in 'non-cured' patients. The effects of year of diagnosis on these parameters were estimated for each TNM cancer stage. With the hazard regression model, the excess death hazard decreased significantly with more recent years of diagnoses (hazard ratio, HR 0.97 in stage III and 0.98 in stage IV, P 0.5). The two models were complementary and concordant in estimating colon cancer survival and the effects of covariates. They provided two different points of view of the same phenomenon: recent years of diagnosis had a favourable effect on survival, but not on cure

Author's reply to : Pancreatic cancer : Extension of tumor is associated with timeliness of care and with survival in a population-based study

Lettre à l'éditeur ("International Journal of Cancer" )http://onlinelibrary.wiley.com/doi/10.1002/ijc.31264/abstract;jsessionid=BF4266372FB7FD8082F8ECE287E2BA65.f01t0

Trends in net survival from colon cancer in six European Latin countries: results from the SUDCAN population-based study.

IF 2.415International audienceColon cancer represents a major public health issue. The aim of the SUDCAN collaborative study was to compare the net survival from colon cancer between six European Latin countries (Belgium, France, Italy, Portugal, Spain, and Switzerland) and provide trends in net survival and dynamics of the excess mortality rates up to 5 years after diagnosis. The data were extracted from the EUROCARE-5 database. First, net survival was studied over the 2000-2004 period using the Pohar-Perme estimator. For trend analyses, the study period was specific to each country. Results were reported from 1992 to 2004 in France, Italy, Spain, and Switzerland and from 2000 to 2004 in Belgium and Portugal. These analyses were carried out using a flexible excess rate modeling strategy. There were few differences between countries in age-standardized net survivals (2000-2004). During the 2000-2004 period, the 5-year net survival ranged between 57 (Spain and Portugal) and 61% (Belgium and Switzerland). The age-standardized survival at 1 and 5 years after diagnosis increased between 1992 and 2004. This increase was observed at ages 60 and 70, but was less marked at 80. This increase was linked to a marked decrease in the excess mortality rate between 1992 and 2004 until 18 months after diagnosis. Beyond this period, the decrease in the excess mortality rates among countries was modest and nearly the same whatever the year of diagnosis. There were minor differences in survival after colon cancer between European Latin countries. A considerable improvement in the 5-year net survival was observed in all countries, but the gain was mainly limited to the first 18 months after diagnosis. Further improvements are expected through the implementation of mass screening programs

Goodness-of-fit tests for parametric excess hazard rate models with covariates

In this paper we propose a general methodology for testing the null hypothesis that an excess hazard rate model, with or without covariates, belongs to a parametric family. Estimating the excess hazard rate function parametrically through the maximum likelihood method and non-parametrically (or semi-parametrically) we build a discrepancy process which is shown to be asymptotically Gaussian under the null hypothesis. Based on this result we are able to build some statistical tests in order to decide wether or not the null hypothesis is acceptable. We illustrate our results by the construction of chi-square tests which the behavior is studied through a Monte-Carlo study. Then the testing procedure is applied to a population based colon cancer data

Health-related quality of life is a prognostic factor for survival in older patients after colorectal cancer diagnosis: A population-based study

International audienceBackground: Studies carried out in the context of clinical trials have shown a relationship between survival and health-related quality of life in colorectal cancer patients.Aims: We assessed the prognostic value of health-related quality of life at diagnosis and of its longitudinal evolution on survival in older colorectal cancer patients. Methods: All patients aged >= 65 years, diagnosed with new colorectal cancer between 2003 and 2005 and registered in the Digestive Cancer Registry of Burgundy were eligible. Patients were asked to complete the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 at inclusion, three, six and twelve months after. Multivariate regression models were used to evaluate the prognostic value of health-related quality of life scores at diagnosis and their deterioration on relative survival.Results: In multivariate analysis, a role functioning dimension lower than median was predictive of lower survival (hazard ratio = 3.1, p = 0.015). After three and six months of follow-up, patients with greater appetite loss were more likely to die, with hazard ratios of 4.7 (p = 0.013) and 3.7 (p = 0.002), respectively.Conclusions: Health-related quality of life assessments at diagnosis are independently associated with older colorectal cancer patients' survival. Its preservation should be a major management goal for older cancer patients. (C) 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved

Dans l’hépatite chronique C, les délais entre diagnostic et traitement sont liés à la relation médecins-patients

Une étude épidémiologique menée en 2004 en Côte d’Or et dans le Doubs révélait que parmi 1 251 patients porteurs du VHC, un sur 4 était traité et un sur 6 ne bénéficiait d’aucune prise en charge. Une étude qualitative faite en Bourgogne en 2006-2008 visait à identifier les raisons de l’insuffisance de soins ; 25 médecins ont été interrogés sur leur confrontation à l’infection par le VHC et les difficultés de sa prise en charge, et 27 patients atteints d’hépatite chronique C sur les circonstances du dépistage et du diagnostic, l’itinéraire de soins, la représentation et le vécu de la maladie et du traitement, les relations avec les soignants. L’étude a révélé une grande variabilité dans les délais entre le diagnostic, la consultation en hépatologie et l’instauration du traitement ; celle-ci est en grande partie expliquée par les modalités du fonctionnement de la relation médecinspatients et des choix de prise en charge faits par les médecins impliqués

Continuing rapid increase in esophageal adenocarcinoma in England and Wales.

BACKGROUND AND AIMS: Substantial changes have occurred in the epidemiology of esophageal adenocarcinoma. We examined trends in incidence in a large national population. METHODS: All esophageal adenocarcinomas registered in England and Wales over a 31-year period (1971-2001) were included. Incidence rates were calculated by age, sex, and socio-economic category, by 5-year period, and by birth cohort. RESULTS: A total of 43,753 esophageal adenocarcinomas were analyzed. Age-standardized (world) incidence rates rose rapidly, by an average of 39.6% (95% CI 38.6-40.6) every 5 years in men, and 37.5% (35.8-39.2) every 5 years in women. Incidence has increased about three-fold in men and women since 1971. Incidence has risen in all deprivation categories since 1986, especially in the most affluent groups. The cumulative risk of esophageal adenocarcinoma over the age range 15-74 years in men rose ten-fold, from 0.1% for those born in 1900 to 1.1% for those born in 1940. The cumulative risk rose five-fold in women. CONCLUSIONS: The incidence of esophageal adenocarcinoma has increased sharply over the past few decades, both by period and birth cohort. Etiological studies are required to explain the rapid increase of this lethal cancer

Chemotherapy of metastatic colon cancer in France: A population-based study

International audienceAims: to describe, using data from a cancer registry in a well-defined French population, the therapeutic strategies and survival of patients with metastatic colon cancer (mCC).Methods: all patients with synchronous mCC diagnosed within the 2005-2014 period recorded in the digestive cancers registry of Burgundy were included.Results: 1286 mCC patients were included (57% male), of which 34.5% did not receive any antitumor treatment. Both, advanced age (≥75 years) and the Charlson comorbidity score ≥2 were significantly associated with the absence of antitumor treatment. Among the patients treated with chemotherapy, 59 and 33% received at least two and three lines, respectively. Most patients treated with chemotherapy (68%) did not receive first-line targeted therapy. Of patients aged ≥75 years, 57% received no chemotherapy and 56% of treated patients had first-line treatment only.Conclusion: this population-based study shows that more than one-third of patients with mCC receive no chemotherapy and that only 59% of treated patients receive treatment beyond the first line. This study also highlights the fact that more than half of patients ≥75 years do not get any antitumor treatment. In patients <75 years, the proportion of patients receiving chemotherapy and/or undergoing curative intent surgery tended to increase over time

Trends in gastric cancer incidence: a period and birth cohort analysis in a well-defined French population

International audienceThe incidence of gastric cancer has declined over the past decades. Little is known about trends by site and histological subtype. The aim of this study was to analyze changes in gastric cancer incidence patterns in a French well-defined population.Data on patients with an epithelial gastric cancer diagnosed between 1982 and 2011 were collected by the population-based digestive cancer registry of Burgundy (n = 4694). Time trends in gastric cancer incidence by period of diagnosis and birth cohort were analyzed by sex, subsite, and histological type.There was a decrease in incidence rates for antral carcinomas (-2.6 % per year in males, -2.5 % per year in females; p < 0.001) and corpus carcinomas (-3.3 % and -3.2 %, respectively; p < 0.001). Annual percentage changes were not significant for fundus carcinomas in both sexes and cardia carcinoma in females, although they increased in males (+1.0 % per year; p < 0.02).When comparing the 1900 cohort and the 1950 cohort, there was a five- to sevenfold decrease in the cumulative risk at 0-79 years for corpus and antral carcinomas in both sexes and a threefold decrease for fundus carcinomas. There were minor variations for cardia carcinomas. There was a decrease of incidence both by period of diagnosis and by birth cohort for adenocarcinoma and colloid carcinoma. It was more marked for undifferentiated carcinoma. The variation for signet-ring carcinoma was minor.Temporal variations in incidence rates of gastric cancer differed according to subsite and histology, suggesting different etiological factors. Available analytical studies provide an explanation for the reported trends by subsite